®Short walk
Walk at a comfortable pace on a flat route. If your symptoms rise no more than slightly and settle quickly, you can make the walk a little longer each day.
Start with a few minutes; 10–15 minutes in stage 324–48 hoursRelative rest, then a gradual return to light activity
Day 21Earliest return to competitive sport (UK grassroots sport guidelines)
13 vs 17 daysMedian recovery time (the time by which half had recovered) in teenagers doing light aerobic exercise versus stretching only
10 daysIf dizziness, neck pain or headache lasts longer than this, neck and balance rehabilitation is recommended
Check these first
If any of the following apply after a blow to the head, get medical help straight away rather than using this guide. Do not drive yourself to the emergency department.
Call 112
- The person was knocked out and has not woken up, or is struggling to stay awake
- They have had a seizure (fit)
- They have difficulty speaking, understanding, walking or keeping their balance, or numbness or weakness in part of the body
- They have problems with their vision or hearing
- Clear fluid or blood is coming from the ears or nose, or there is bruising behind the ears
- They fell from more than 1 metre or 5 stairs, or were hit at speed, such as in a car or bike accident
Go to the emergency department
- The person was knocked out briefly but has woken up
- They have vomited, or keep vomiting
- They have a headache that painkillers do not ease, or that keeps getting worse
- They have memory problems, increasing drowsiness, irritability or a change in behaviour; a baby or young child is crying more than usual
- They take blood-thinning medicine, have a bleeding disorder or have had brain surgery
- They had alcohol or drugs just before the injury
Symptoms
- Headache, dizziness, nausea.
- Feeling dazed or “foggy”, difficulty concentrating and remembering.
- Sensitivity to light or noise, tiredness, changes in sleep.
- Changes in mood, such as irritability, anxiety or tearfulness.
Symptoms usually start within 24 hours, but can be delayed by up to 3 weeks. Mild symptoms can last up to 2 weeks; most symptoms settle within 2–4 weeks, though some can take longer.
The first 24–48 hours
- Have an adult with you for the first 24 hours; do not stay on your own.
- Rest and sleep as much as you need; keep phone, computer and screen time to a minimum.
- Do not drink alcohol; do not take sleeping pills unless your doctor recommends them.
- Do not ride a bicycle or operate machinery for the first 24 hours; do not drive until you have fully recovered.
- Ask your doctor before taking a painkiller for a headache; Ireland’s health service (HSE) recommends paracetamol rather than ibuprofen or aspirin during this period, as they could increase bleeding. You can put ice wrapped in a towel on any swelling.
A gradual return to activity and sport
The UK guidelines for grassroots sport, produced with government support, describe the return in six stages. It is fine for your symptoms to rise slightly as you move on to the next stage, as long as the activity makes them no more than mildly worse and the increase settles within minutes to a few hours. If symptoms get clearly worse, go back to the previous stage.
- 1. Relative restFirst 24–48 hours: calm activities, minimal screen time.
- 2. Everyday tasks and light activityShort, easy reading, short walks, light household tasks.
- 3. Building toleranceMental tasks in blocks of 20–30 minutes; 10–15 minutes of light aerobic exercise (walking, exercise bike).
- 4. Part-time school or work, non-contact trainingOnce you have no symptoms at rest, usually around week 2.
- 5. Full-time school or work, unrestricted trainingDay 15 at the earliest; after 14 days without symptoms at rest.
- 6. Return to competitionNot before day 21; after 14 days without symptoms at rest.
Returning to school or work comes before returning to sport. The guidelines’ principle is clear: if in doubt, sit them out. Someone with suspected concussion does not go back to the game, training or PE that day, and stays away from them for at least 24 hours.
What does the research show?
According to the international consensus agreed in Amsterdam in 2022 and published in 2023, strict rest is not recommended; everyday tasks and light aerobic exercise such as walking or an exercise bike may help recovery, and limiting screen time in the first 48 hours may also help. The consensus recommends neck and balance rehabilitation for people whose dizziness, neck pain or headache lasts longer than 10 days, and an assessment involving different specialties for those whose symptoms last more than 4 weeks.
One of the studies behind these recommendations was carried out in the USA and Canada with 103 young athletes: within the first 10 days, half of those doing about 20 minutes of aerobic exercise a day at an intensity that did not worsen symptoms (80% of the heart rate at which symptoms increased on a treadmill test) had recovered within 13 days, and half of those doing stretching only within 17 days (median time). Recovery took longer than 30 days in 2 of 52 people in the exercise group and 7 of 51 in the stretching group; however, this difference was not statistically significant. The studies were mostly done in young athletes; the evidence is more limited in adults and in non-sport injuries.
Exercises at home
Six exercises for light movement and balance
These movements are started in stages 2 and 3, after the rest period. The head movement and balance exercises come from a children’s hospital information sheet on balance after concussion. Each movement should make your symptoms no more than mildly worse; if dizziness persists or you are afraid of falling, get checked by a physiotherapist or doctor.
Gaze stabilisation: head turns
Hold a pen or a card at arm’s length and keep your eyes on it. With your eyes locked on the object, slowly turn your head from side to side. Only speed up when you are ready.
5–10 reps, as toleratedLooking up and down
Sit upright. Slowly lift your head to look at the ceiling, then lower it to look at the floor. The aim is to help your brain get used to head movement again; any dizziness should stay mild and pass quickly.
5–10 repsTilting the head sideways
Sit upright. Slowly bring your ear towards your shoulder, come back to the middle and tilt to the other side. Do not lift your shoulder.
5–10 reps each sideTandem stance and walk
Stand next to a wall. First stand for 10 seconds with one foot slightly in front of the other, then swap feet. When this becomes easy, with someone beside you, walk along a corridor placing the heel of one foot against the toes of the front foot.
10 seconds with each foot in front; then 20 stepsStanding on one leg
Holding a sturdy chair, stand on one leg. When it gets easier, let go and hold for longer; later you can make it harder, for example by closing your eyes or drawing letters in the air.
Start with 10 seconds, up to 30 secondsFrequently asked questions
Don’t I need to rest in a dark room?
No. Long, strict rest is no longer recommended. In a study of 88 patients aged 11–22, those told to rest completely at home for 5 days reported more symptoms, and their symptoms cleared more slowly, than those who rested for 1–2 days and then gradually returned to activity. Rest relatively for the first 24–48 hours and sleep as much as you can; then gradually return to everyday tasks and gentle walks.
Can I use my phone and computer?
Keeping screen time to a minimum in the first 48 hours may help recovery. After that you can use screens for short periods with breaks; in stage 3, mental tasks are recommended in blocks of 20–30 minutes.
When can I go back to school or work?
When you feel better, starting with short periods. England's grassroots sport guidance puts returning to school and work before returning to sport: once you have no symptoms at rest, usually around week 2, you can return to school or work part-time. During this period you can ask for adjustments such as half days or scheduled breaks.
When can I return to sport?
You return to training gradually; you do not return to contact or competitive sport before day 21 after the injury, and you need to have been free of symptoms at rest for at least 14 days. The NHS also advises staying away from contact sports for at least 3 weeks. Children should avoid rough play for the first few days. According to the international consensus, most people are fully back in their sport within about a month.
Does exercise speed up recovery?
Light aerobic exercise can help. In a study of 103 young people aged 13–18 with a sport-related concussion, half of those who started within the first 10 days and did about 20 minutes of walking or stationary cycling a day, at an intensity that did not worsen symptoms, had recovered within 13 days (median time); in those doing stretching only this was 17 days. Exercise intensity should increase your symptoms only mildly at most.
What should I do if my symptoms don’t go away?
If symptoms do not improve within 2 weeks or get worse, see your doctor; if they last more than 4 weeks, an assessment by several specialties is recommended. If dizziness, neck pain or headache lasts more than 10 days, the international consensus recommends neck and balance (cervicovestibular) rehabilitation. In a small study of 31 people aged 12–30 whose dizziness, neck pain or headache persisted after a sport-related concussion, 73% of those who received this rehabilitation were cleared to return to sport within 8 weeks, compared with 7% of those who received general physiotherapy only (postural education, range-of-motion exercises, graded exertion).
For neck pain after a blow to the head, see the whiplash guide; for headache, the headache guide; for brief spinning that starts when you turn your head, the dizziness (BPPV) guide.
When should you see a doctor?
- Your symptoms are getting worse or have not improved within 2 weeks
- You are unsure whether it is safe to drive or go back to work, school or sport
- Your symptoms last longer than 4 weeks: do not return to sport until you have been assessed
- If any of the emergency signs above appear later, call 112 or go to the emergency department straight away
Sources
- Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport – Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695–711. Summary: BMJ Group, 14 June 2023.
- Sport and Recreation Alliance, UK Government. UK Concussion Guidelines for Non-Elite (Grassroots) Sport. November 2024 update.
- NHS 111 Wales. Head injury and concussion. Last updated 19 November 2024.
- HSE (Health Service Executive, Ireland). Head injury and concussion. Last reviewed 20 September 2024.
- Leddy JJ, Haider MN, Ellis MJ, et al. Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatr. 2019;173(4):319–325. Summary: University at Buffalo, February 2019.
- Thomas DG, et al. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015;135(2):213–223. Summary: Contemporary Pediatrics.
- Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med. 2014;48(17):1294–1298.
- Sydney Children’s Hospitals Network. Concussion aftercare: balance information sheet. Last updated 4 August 2026.